Good Faith Estimate

Right to Receive a Good Faith Estimate

Under the No Surprises Act, all healthcare providers, including Licensed Clinical Social Workers, are required to provide a Good Faith Estimate (GFE) to clients who are uninsured or choose to "self-pay" (not use insurance) for services.

You have the right to receive a "Good Faith Estimate" explaining how much your care will cost. In my practice, this applies to psychotherapy services and any related costs reasonably expected for your care.

Your Rights Regarding the Good Faith Estimate

Written Estimate: You have the right to receive a Good Faith Estimate for the expected cost of any non-emergency items or services.
Timing: I will provide your Good Faith Estimate in writing no later than 3 business days after you schedule a service. If you schedule an appointment with less than 3 business days' notice, you will receive your estimate no later than 1 business day before your appointment. You may also request a Good Faith Estimate at any time before scheduling a service.
The $400 Rule: If you receive a bill that is at least $400 more than your Good Faith Estimate, you have the right to dispute the bill through the federal Patient-Provider Dispute Resolution process. You must initiate the dispute within 120 calendar days of the date on the original bill. There may be a small administrative fee to use this process.
Record Keeping: Make sure to save a copy or picture of your Good Faith Estimate for your records.

Important Disclaimers

The Good Faith Estimate shows the costs of items and services that are reasonably expected for your health care needs based on information known at the time the estimate was created.
The estimate does not include any unknown or unexpected costs that may arise during treatment (e.g., if we decide to increase session frequency or if a crisis requires additional support). You could be charged more if such circumstances occur.
This estimate covers the cost of expected psychotherapeutic services for a given time period. Psychotherapy is an open-ended process. By associating this estimate with a given time period, we do not intend to imply or suggest that services will only be needed through this time period. A new estimate will be provided for additional services, should they be needed, after this time period.
The Good Faith Estimate is not a contract and does not require you to obtain services from me.

Questions or Disputes?

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 1-800-985-3059.

For specific questions regarding your billing or to request an estimate before scheduling your first session, please contact us directly at info@realizeinsight.com or +1-571-506-3455.